June 9, 2021 – Fewer adults with diabetes in the United States have well-controlled blood sugar or blood pressure now compared to 10 years ago, a trend that should be a “wake-up call”, the authors of a new study published today in New England Journal of Medicine
The researchers analyzed data from five major health and nutrition surveys of Americans over the past 20 years, called National Health and Nutrition Examination Surveys.
They aimed to find out how many people with diabetes met the three recommended ABCs with good diabetes control:
- A1c, a measure of blood glucose control: less than 7%
- Blood pressure: less than 1
- Cholesterol (non-HDL cholesterol or “bad” cholesterol): less than 130.
From 1999 to 2010, diabetes treatment improved, but since then, progress has stalled.
In the most recent study conducted from 2015 to 2018, only 22% of diabetics had all three interventions under good control.
‘Regarding findings, an awakening call’
“These trends are a wake-up call,” said the study’s lead author, Michael Fang, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“They mean that millions of Americans with diabetes are at greater risk for major complications,” he said in a statement from the university.
Complications of poorly controlled diabetes include foot amputation, kidney disease and heart attack.
The results “relate” to the agreed-upon senior study author Elizabeth Selvin, PhD, professor at Bloomberg School’s Department of Epidemiology.
“There has been a real decline in glycemic control from a decade ago, and in general only a small proportion of diabetics meet the main goals of glycemic control, blood pressure control and high cholesterol control at the same time,” she summed up.
Selvin suggests that two major clinical trials published in 2008 may partly explain these disturbing new trends.
The experiments showed that treating patients with diabetes medication to achieve very low blood sugar goals did not reduce the risk of outcomes such as heart attacks and strokes.
And some people who received this intensive treatment were more likely to develop dangerously low blood sugar levels (hypoglycemia).
“As a result of these trials, what we may see is that physicians in people with diabetes may have withdrawn slightly from glycemic control with potentially harmful results,” Selvin speculated.
However, many new, safer diabetes medications have become available since these trials, she noted, though cost is still an issue.
Generic diabetes drugs on the horizon
The researchers analyzed data from 6,653 adults with diabetes who participated in national health surveys conducted from 1999-2002, 2003-2006, 2007-2010, 2011-2014 and 2015-2018.
The percentage of people with good blood sugar control increased from 44% in the first study to 57% in the 2007-2010 study and then decreased to 51% of the final study.
Importantly, the proportion of people with good control of all three measures of diabetes treatment increased from 9% in the first study to 25% in study three, but then decreased to 22% in the final study.
The use of other newer second-line drugs for blood sugar control (generally given after trials of metformin, first-line treatment for type 2 diabetes) has increased, but is still low, the researchers note.
Many of these newer diabetes drugs will become generic and more affordable over the next many years, they expect, which may help stop this trend of worsening diabetes regulation.
Meanwhile, they say doctors should prescribe more of the drugs that the guidelines recommend are used first to treat high levels of blood sugar, blood pressure and bad cholesterol.
Only 56% to 60% of patients with diabetes were given metformin, ACE inhibitors or angiotensin receptor blockers (ARBs) for high blood pressure or statins for high cholesterol.